慢性肾脏病各期唾液酸、同型半胱氨酸及胱抑素C水平的变化及其临床意义

Study on the changes of sialic acid,homocysteine and cystatin C levels in chronic kidney disease stages and their clinical significance

目的：探讨慢性肾脏病（CKD）各期胱抑素C（Cys C）、同型半胱氨酸（Hcy）、唾液酸（SA）的水平变化。方法：选择CKD病人129例（CKD 1期31例,2期18例,3期17例,4期12例,5期51例）作为研究组,同期健康体检者32例作为对照组,收集研究对象Cys C、Hcy、SA数据进行统计分析。结果：CKD各期Hcy、Cys C、SA逐渐升高,与对照组间差异均有统计学意义。其中Cys C在CKD各期间差异均有统计学意义;Hcy在CKD 5期与1、2、3期间差异具有统计学意义,2、3、4期间差异无统计学意义,1期与2、3、4、5期间差异均有统计学意义;SA在CKD 5期与1、2、3、4期间差异均有统计学意义;Spearman相关性分析显示,Hcy、SA、Cys C与e GFR均呈负相关（r=-0.606,P=0.000;r=-0.571,P=0.000;r=-0.911,P=0.000）;Logistic回归分析显示,以e GFR为因变量,Cys C（OR=29.816,95%CI为7.490-118.69,P=0.000）和Hcy（OR=1.107,95%CI为1.024-1.198,P=0.011）具有统计学意义。结论：Cys C与Hcy是CKD开始恶化的独立危险因素;SA对CKD进展到终末期的判定具有临床意义。

Objective： To study the changes of cystatin C（ Cys C）,homocysteine（ Hcy） and sialic acid（ SA）levels in different stages of chronic kidney disease（ CKD）. Methods： One hundred and twenty-nine patients with CKD were selected as study subjects,of whom 31 were in CKD stage 1,18 in stage 2,17 in stage 3,12 in stage4 and 51 in stage 5,and 32 healthy persons were served as the controls. Their clinical data were collected and statistically analyzed. Results： The levels of Hcy,Cys C and SA increased gradually in CKD stages,and the differences between the subject group and the control group were statistically significant. The differences of Cys C between the stages were statistically significant in all stages of CKD; the differences of Hcy were statistically significant between the stage 5 of CKD and stage 1,2 and 3,while the differences among stage 2,3 and 4 were statistically insignificant,and the differences between stage 1 of CKD and the other 4 stages were statistically significant. The differences of SA were statistically significant between stage 5 and the other 4 stages. Spearman relativity analysis showed that Hcy,SA and Cys C were negatively correlated with e GFR（ r =- 0. 606,P = 0. 000;r =- 0. 571,P = 0. 000; r =- 0. 911,P = 0. 000）. e GFR as the dependent variable,Logistic regression analysis showed that Cys C（ OR = 29. 816,95% CI = 7. 490- 118. 69,P = 0. 000） and Hcy（ OR = 1. 107,95% CI = 1. 024-1. 198,P = 0. 011） have statistical significance. Conclusion： Cys C and Hcy are independent risk factors for the deterioration of CKD. SA has clinical significance in the diagnosis of CKD at the final stage.